Question 1

Are HSP more prone to depression and anxiety?

Elaine Aron · Accepted Answer

With HSPs, it is always a matter of differential susceptibility (see studies by Michael Pluess, Jay Belsky, and others, at hsperson.com, research tab).  When HSPs have had good-enough childhoods and/or are living in not too stressful conditions, they are actually less prone to depression, and somewhat less to anxiety as well.  (The issue with anxiety is that all HSPs are more aware of dangers as well as opportunities and process these more deeply.  Hence, what is a normal level of anxiety/worry for HSPs would be different for those less aware of dangers.)   If they have had an adverse childhood environment, they are more susceptible to depression, anxiety, shyness, and poor health.

Question 2

What should therapists know about treating trauma in a HSP?

Elaine Aron · Accepted Answer

I do not consider myself an expert in the latest ways of treating trauma, but it is generally better to keep HSPs in an optimal level of arousal during therapy, aroused enough to be alert and processing what is happening, but not so overaroused that they have shut down.  This would be retraumatizing.  But I imagine those working with trauma always have to watch for this.  With HSPs, the sense of overarousal would just come sooner.  Also, what may not seem traumatizing to someone without the trait could be very much a trauma for an HSP.

Question 3

Are there any advantages to being a HSP?

Elaine Aron · Accepted Answer

There are many, many advantages, and these I list first are research based (one can imagine others as an outgrowth of these) and always in comparison with those scoring lower on the HSP Scale, sometimes using brain activation studies:  Greater empathy, creativity, conscientiousness, attunement to one's children, depth of processing of information, less susceptibility to culturally-induced perceptual biases, a rich and complex inner life, greater appreciation of the arts and music, a stronger response to positive stimuli, greater improvement from interventions to increase resilience or limit the impact of bullying, and greater openness to experience.  In addition many HSPs report a greater sense of humor, more spiritual interest, and special leadership abilities.  This is the short list!

Question 4

Do HSP get drawn to each other and tend to be friends, colleagues etc? Is it good for two HSP to be in a relationship and is it good for a HSP to have a therapist who is also a HSP?

Elaine Aron · Accepted Answer

There is no research (and it would be difficult to do) demonstrating that HSPs are drawn to each other more than to those not having the trait.  There are advantages to both kinds of relationships, two HSPs together and one HSP with one not.  I have written about that in The Highly Sensitive Person in Love. In Psychotherapy and the Highly Sensitive Person I have written about the advantages of when the therapist is and is not an HSP.  That said, I think all HSPs need to know some other HSPs in order to sense the reality of their trait.

Question 5

Other than avoidance, what strategies can I recommend to clients with this trait to cope with over-stimulation?

Elaine Aron · Accepted Answer

Since overstimulation/overarousal is the only problem with the trait that is really built-in, I have written about this extensively.  Certainly one does not want to simply avoid stimulation, but limiting it to what is personally tolerable is a coping strategy every human being uses.  No shame there.  As for other strategies, one might begin with the book The Highly sensitive Person, in the chapter on "general health and lifestyle."

When one knows a client will be in a highly stimulating situation, help them prepare for it, use various strategies to deal with it while in it, and allow time to recover.  At the top of my list for doing all three is always meditation, as it is the most efficient way to get deep rest before, during, or after a full serving of activity.  Deep rest is especially the focus of Transcendental Meditation.

TM is very effortless (it is okay to sit any way that is comfortable, sleep if you get sleepy, or have many thoughts).  I have been doing it 49 years and rarely miss, only because I still love doing it.  But for it to work you really must learn from and pay for the highly trained TM  teachers found all over the world.   But the TM organization does offer financial help.  And of course TM does not solve everything!  And other forms of meditation have their value too.

I cannot type in the TM websites and videos without getting their popups in the middle of my answer, so I will be trickier.  One is tmhome and then .com.  The other is just tm and then .org.

Good videos (again, I am avoiding the links):

Search for  "jerry seinfeld tm good morning america"

A good intro talk, search in videos for "how tm works bob roth"

If you like David Lynch, search for "david lynch tm creativity"

Question 6

How is the sensitivity trait related to other personality factors such neuroticism, introversion and conscientiousness?

Elaine Aron · Accepted Answer

These three personality traits are found in the “Big Five” measures of personality (there are several such measures). Many research studies have looked at the relation of the Big Five to the measure of high sensitivity, the HSP Scale.  Taken together, there are weak statistical associations with only two:  Neuroticism and Openness to Experiences. (The association with introversion, although positive, is not statistically significant.)

In this case “neuroticism” does not refer to any disorder, but to the tendency to have negative feelings--depression, anxiety, and anger. The association with sensitivity is through anxiety.  HSPs are more aware than others of both risks and opportunities.  If you notice more risks, you will be more anxious, so Neuroticism is in a sense a normal part of the trait, although it can certainly be increased with negative experiences.

Remember, both the HSP Scale and the Big Five are measured by questionnaires, and all questionnaires give us only approximations of the “real thing.” (For example, the HSP Scale has many more negatively than positively worded items, perhaps also adding to the association with Neuroticism.) Second, the Big Five measures personality.  Personality means a combination of what is innate plus life experiences.  Research suggests that high sensitivity is largely innate.  That is, present from birth.

The main point is that there is little overlap between these standard personality traits and high sensitivity, perhaps because the Big Five traits are entirely based on terms people use to describe other people, while the trait of high sensitivity is more difficult for others to observe (for example, greater depth of processing) and thus has not been as much or as clearly in our vocabulary.

Question 7

How do you differentiate between trait high sensitivity and an anxiety disorder e.g., GAD or SAD?

Elaine Aron · Accepted Answer

In Psychotherapy and the Highly Sensitive Person, Appendix B, I deal with differentiating between DSM diagnoses as well as co-occurrences.  It is a bit out of date, based on DSM 4, but it will be clear enough, I think.

For both disorders, the decision is  highly dependent on defining “excessive” (“excessive anxiety and worry occurring more days than not for at least 6 months”).  Many HSPs, especially those under stress and with poor childhoods,  would meet the symptoms criteria, such as, those for GAD:  feeling on edge, easily fatigued, trouble concentrating or mind going blank, irritability, muscle tension, and sleep disturbance.  It all would depend on the level of distress and impairment.  The question is whether a diagnosis is really needed, for treatment or insurance purposes.  There are co-occurrences of course, and the history helps to determine if past events have rendered a patient more chronically anxious than others with the trait.

The criteria for SAD are perhaps some of the vaguest in DSM 5, in that almost everyone has had, at some point in life, bouts of “marked” fear of one or more social situations in which they fear being “exposed to possible scrutiny by others.”  It is a disorder if it “out of proportion” or lasts for six months or more. DSM views this as different from “normative shyness,” and explains that only 12% of self-identified shy persons see themselves as having symptoms that meet the criteria for this disorder, which must interfere significantly with an individual’s normal routine and cause them distress.

That is, if a person can design a life in which fear of being judged by others does not occur, they would not meet criteria. Keep in mind that sensitive persons are even more aware of the fact that people do scrutinize each other and that these situations are overarousing, and overarousal impairs their response, causing them to feel even more scrutinized, and this cycle may well make their fear a reality.  All of this becomes a disorder when they are utterly powerless to overcome their fear in almost all situations.  You may also see persons with true Social Phobia who are not highly sensitive.

Question 8

Do highly sensitive people often present with somatic symptoms?

Elaine Aron · Accepted Answer

Naturally they do, partly because stress often manifests as somatic symptoms, and they are often under more stress.  Somatic symptoms can also be the result of dissociated trauma, and HSPs have often been exposed to trauma.

If the question is, do they often have somatic symptom disorders, be aware that they are by nature more aware of their bodily processes, so that they will notice symptoms sooner and be more concerned and affected by them.  They also tend to have lower pain thresholds, more reactive immune systems, and undoubtedly stronger reactions to consciousness-altering substances.   They have more side effects from medications, so that they need lower doses and still may not be able to tolerate these effects (Jagiellowicz et al., 2007).

Finally, they may be anxious about their health simply because their trait involves considering all possibilities, including that their doctor has overlooked something or they did not explain something clearly enough. They will have more questions about tests and treatments and be more interested in alternative medicine and prevention.

Since most physicians are presumably not highly sensitive, they often have a low view of these time consuming, "complaining" patients, and psychotherapists may accept the perspective of their fellow professionals and see a HSP's somatic preoccupations as excessive.   Obviously too much focus on symptoms that are not a problem can occur, but remember of course you are not trained to decide about the actual health significance of physical symptoms.  (One must also watch out for highly sensitive patients who fail to seek medical attention when they ought to because of past experiences of feeling shamed or just being wrong.)

Question 9

Do HSP struggle more with emotion regulation than non-HSP? What interventions best help with this?

Elaine Aron · Accepted Answer

I have written about emotional regulation here.  https://hsperson.com/emotional-regulation-and-hsps/  There are over 100 comments on the article that may be helpful as well, giving a good sense of what others struggle with and solutions they have found.

Question 10

I am a psychotherapist and a HSP. Am I in the wrong career? I do worry that I take on too much.

Elaine Aron · Accepted Answer

No, you are not in the wrong career, but yes, you probably do take on too much!  I have written extensively about this on my webpage.  Please read https://hsperson.com/resources/just-for-highly-sensitive-therapists-and-coaches/

Question 11

Is equine assisted therapy beneficial for HSP? When might I think about referring a client on for this?

Elaine Aron · Accepted Answer

I think almost always.  We run a Highly Sensitive Person and Horses workshop when we can (not now) and have witnessed so much growth from it.  Just quietly observing horses seems to help.  As for when, I trust your clinical skills to decide!

Question 12

Are there gender differences in the trait of high sensitivity?

Elaine Aron · Accepted Answer

There are no differences in the number of males and females born with the trait.  But in many cultures the trait is discouraged, so that men seem to cover it up, consciously or not.  Probably this is why men score lower on the HSP Scale than women.  It is interesting that when the scale was constructed, no item was included that showed any differences in how the sexes responded.  But when men answer the entire scale, they score lower, so taking the entire scale seems to have some special effect on how they answer.

Question 13

Hello, I need to attend a course for HPS , can you help me please?

Elaine Aron · Accepted Answer

You are right that you need to attend a course for HSPs if you have not already.  It is a very good idea, for many reasons.

I am writing this during the pandemic, so there are only online courses.  But watch hsperson.com, the tab for Events, for what is happening.  Or subscribe to my email, although that is on pause until February.

Right now there are two regular events.  You can attend an "Are You Highly Sensitive LIVE" webinar with Alane Freund on first Fridays of the month for general topics and 3rd Mondays for parents.   These are $37/mo., but no one is turned away for lack of funds. Go to Areyouhighlysensitive.com

Jacqulyn Strickland, who has been running HSP Gathering Retreats, in person, all over N. America and Europe, has some courses on line.  You can find them at lifeworkshelp.com.

One time only:

December 5--Second Highly Sensitive Men’s Seminar, this is by Zoom:  "Meaningful Work for a Fuller Life."  This will cover all kinds of work, whether you are retired, a student, or currently “working” in the usual sense.  Led by Tracy Cooper, John Hughes, Will Harper, and Tom Falkenstein.  Search for eventbrite HS men.  That should get you there.

March 6, 2021—San Francisco Jung Institute. "Psychotherapy with Highly Sensitive Patients:  From Jung to Now."   I will discuss Jung’s concept of sensitiveness and then the best practices when psychotherapists are seeing HSPs.  Anyone can attend.  Continuing Education (3 hrs) available. Searching for SF Jung Elaine Aron should get you there.

Question 14

How can I best support my HSP clients during times of transition and uncertainty?

Elaine Aron · Accepted Answer

I have written about this in a blog.  https://hsperson.com/uncertainty/#comments.  I highly suggest that your clients read the comments as well. Not because of the nice things about me! But because might help provide the vitally needed reassurance and community for HSPs.  Many wrote about HSPs and Covid.

In general, we talk about five things HSPs need.  One: To know their trait is real. Reading the research helps some people.  The number of people also identifying with it helps others.

Two:  Reframe their life (decisions, "failures," rejections, judgments of others, shame, etc.).

Three:  Heal from past trauma, which your clients are doing with you.

Four:  Develop the lifestyle appropriate for an HSP.  (You can help with that too).

Five:  Meet other HSPs.  There are many ways to do this online, many Facebook pages for example.  Here are three I suggest:

•	African American and Highly Sensitive.   https://www.facebook.com/groups/205063584175691

•	Elaine Aron and High Sensitivity, moderated by some of the members of the International Consultants on High Sensitivity and focused on the research and my work.  From there you will find more Facebook pages by them.

•	Sensitive, the Movie, https://www.facebook.com/sensitivethemovie This is by Diana Sinelnikova, producer of all of the movies about sensitivity, but it is really about everything going on “HSP” and has lots of followers.

Question 15

What factors need to be taken in consideration with HSPs that might alter a CBT treatment approach?

Elaine Aron · Accepted Answer

Please read Psychotherapy and the Highly Sensitive Person for general advice. Specific to CBT, I would be careful of shaming a client who cannot do what you ask them to do. As you probably do, explore why in a very accepting, positive way, highlighting what the person could do. Consider what parts of their innate trait might be making it harder for them, using DOES. How greater depth of processing, emotional responsiveness, or awareness of subtle stimuli enter in, and especially how all three of these lead, naturally, to being more easily overstimulated and overaroused. Overarousal means poorer performance for anyone doing anything.

Understanding the Highly Sensitive Person